Akinyemiju Tomi F, Naik Gurudatta, Ogunsina Kemi, Dibaba Daniel T, Vin-Raviv Neomi
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
Cancer Causes Control. 2018 Mar;29(3):333-342. doi: 10.1007/s10552-018-1010-7. Epub 2018 Feb 10.
This study examines whether racial disparities in hospitalization outcomes persist between African-American and White women with ovarian cancer after matching on demographic, presentation, and treatment factors.
Using data from the Nationwide Inpatient Sample database, 5,164 African-American ovarian cancer patients were sequentially matched with White patients on demographic (e.g., age, income), presentation (e.g., stage, comorbidities), and treatment (e.g., surgery, radiation) factors. Racial differences in-hospital length of stay, post-operative complications, and in-hospital mortality were evaluated using conditional logistic regression models.
White ovarian cancer patients had relatively higher odds of post-operative complications when matched on demographics (OR 1.35, 95% CI 1.05, 1.74), and presentation (OR 1.28, 95% CI 1.00, 1.65) but not when additionally matched on treatment (OR 1.03, 95% CI 0.78, 1.35). African-American patients had longer in-hospital length of stay (6.96 ± 7.21 days) compared with White patients when matched on demographics (6.37 ± 7.07 days), presentation (6.48 ± 7.16 days), and treatment (6.53 ± 7.59 days). Compared with African-American patients, White patients experienced lower odds of in-hospital mortality when matched on demographics (OR 0.78, 95% CI 0.66, 0.92), but this disparity was no longer significant when additionally matched on presentation (OR 0.88, 95% CI 0.75, 1.04) and treatment (OR 0.95, 95% CI 0.81, 1.12).
Racial disparities in ovarian cancer hospitalization outcomes persisted after adjusting for demographic and presentation factors; however these differences were eliminated after additionally accounting for treatment factors. More studies are needed to determine the factors driving racial differences in ovarian cancer treatment in otherwise similar patient populations.
本研究旨在探讨在对人口统计学、临床表现和治疗因素进行匹配后，非裔美国女性和白人女性卵巢癌患者在住院治疗结果方面的种族差异是否仍然存在。
利用全国住院患者样本数据库的数据，按照人口统计学因素（如年龄、收入）、临床表现因素（如分期、合并症）和治疗因素（如手术、放疗），将5164名非裔美国卵巢癌患者与白人患者进行逐一匹配。使用条件逻辑回归模型评估住院时间、术后并发症和住院死亡率方面的种族差异。
在按照人口统计学因素匹配时（比值比1.35，95%置信区间1.05，1.74）以及按照临床表现因素匹配时（比值比1.28，95%置信区间1.00，1.65），白人卵巢癌患者术后并发症的几率相对较高，但在进一步按照治疗因素匹配后则不然（比值比1.03，95%置信区间0.78，1.35）。在按照人口统计学因素匹配时（非裔美国患者住院时间为6.96±7.21天，白人患者为6.37±7.07天）、按照临床表现因素匹配时（非裔美国患者住院时间为6.48±7.16天，白人患者为6.53±7.59天）以及按照治疗因素匹配时，非裔美国患者的住院时间均长于白人患者。在按照人口统计学因素匹配时，与非裔美国患者相比，白人患者住院死亡率的几率较低（比值比0.78，95%置信区间0.66，0.92），但在进一步按照临床表现因素匹配时（比值比0.88，95%置信区间0.75，1.04）以及按照治疗因素匹配时（比值比0.95，95%置信区间0.81，1.12），这种差异不再显著。
在对人口统计学和临床表现因素进行调整后，卵巢癌住院治疗结果的种族差异仍然存在；然而，在进一步考虑治疗因素后，这些差异消失了。需要开展更多研究来确定在其他方面相似的患者群体中导致卵巢癌治疗种族差异的因素。
